HomeMy WebLinkAboutX2021-2378 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
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NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Project Address (Not mailing address) ❑ Flood [j- Fire D Liq E71La/nd�slide—❑N/A Floor Suite No
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Description of Work
Use(const Type
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# Stories # Units (if Resf
Valuation $
Material/labor
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OWNER'S NAME Last �'(l�Nri �P�%�y First
Owners Owner's E-mail Address
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City 'Ljn/� _� State I Zip Telephone (f
APPLICANT'S NAME Last7-1
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Applicant's Address Applicant's E-mail Address -
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ARCHITECT/DESIGNER'S NAME Last }}'
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Architect/Designer's Address Architect/Designees E-mail Address
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ENGINEER'S NAME Last - First F____ 7_71 Lic. No.r
Engineer's Address Engineer's E-mail Address
city— ___---I State j Zip Telephoned—�
CONTRACTOR'S NAME/COMPANY �� ij!''� Lic. No.9 1 S 1� Class
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Contractor's Address Contractor's E-mail Address
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City State CK}.'----� Zip-'qZ5 0,: Telephone..._j�.fZO �2 �
SETBACKS REAR SETBACKS FRONT - *-OERMIT NO.
SETBACKS LEFT SETBACKS RIGHT , PLAN CHECK NO.
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USE ZONE DEVELOPMENT NO PLAN CHECK FEES $ t (e •�